Provider Demographics
NPI:1780825240
Name:LUXURY REHAB GROUP, LLC.
Entity Type:Organization
Organization Name:LUXURY REHAB GROUP, LLC.
Other - Org Name:SEASONS IN MALIBU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHILATI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:424-234-2060
Mailing Address - Street 1:1801 W. OLYMPIC BLVD,
Mailing Address - Street 2:FILE 1441
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91199
Mailing Address - Country:US
Mailing Address - Phone:424-234-2057
Mailing Address - Fax:424-234-2051
Practice Address - Street 1:6021 GALAHAD RD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4030
Practice Address - Country:US
Practice Address - Phone:818-635-9380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190695AP324500000X
CA8343867324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility